EUROPEAN FEDERATION OF INTERNAL MEDICINE

 

The Practice Of Internists 2008 – Part TWO
 

Procedures performed by Internists

The EFIM/EBIM Working Group on the competencies of the Internist is working on creating a list of diagnostic and therapeutic procedures that are performed by Internists in Europe. While some differences may exist between the European countries, we believe that a limited number of procedures are relatively frequently done in Internal Medicine practice throughout Europe.

The Internist should have the ability to perform a variety of diagnostic and therapeutic procedures. He should be aware of the indications and contraindications, complications and cost of commonly applied procedures. The types of procedures that are generally done by Internists varies significantly between countries. Furthermore, procedures formerly done by Internists are now often performed by medical subspecialists. However, it is important for Internists to acquire and maintain skills in performing common and relatively simple procedures. We have classified the procedures that all Internists should have an ability to perform as essential procedures. More sophisticated procedures that are rarely performed by Internists in most countries, are classified as optional procedures. The medical history and physical examination are not included as these are considered part of the clinical method rather than a procedure.

Procedures Internists may have done historically - like blind liver biopsies - are probably better and safer done under imaging guidance by radiologists. Other procedures Internists should perhaps be getting actively involved in and taking ownership of - in particular bedside ultrasound.

Listed below are essential and optional procedures that in the past have been done by Internists. Please review both lists and indicate how commonly these are performed by Internists in your country.

 
 

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Now for each Procedure listed below select how commonly they are performed by Internists in your country.

ESSENTIAL PROCEDURES
Drawing venous blood Common Uncommon Rare Never
Drawing arterial blood Common Uncommon Rare Never
Urinary catheter placement Common Uncommon Rare Never
Electrocardiogram recording and interpretation Common Uncommon Rare Never
Interpretation of chest X-rays Common Uncommon Rare Never
Doppler examination of peripheral pulses Common Uncommon Rare Never
Nasogastric intubation Common Uncommon Rare Never
Spirometry Common Uncommon Rare Never
Thoracentesis Common Uncommon Rare Never
Abdominal paracentesis Common Uncommon Rare Never
Joint aspiration Common Uncommon Rare Never
Joint and soft tissue injection Common Uncommon Rare Never
Lumbar puncture Common Uncommon Rare Never
Peripheral venous line placement Common Uncommon Rare Never
Arterial line placement Common Uncommon Rare Never
Central venous line placement Common Uncommon Rare Never
Emergency cardiac defibrillation Common Uncommon Rare Never
Emergency endotracheal tube placement Common Uncommon Rare Never
Mechanical ventilation : non-invasive Common Uncommon Rare Never
   

OPTIONAL PROCEDURES
Interpretation of peripheral blood smear Common Uncommon Rare Never
Urine microscopy Common Uncommon Rare Never
Bone marrow aspiration/biopsy Common Uncommon Rare Never
Skin (punch) biopsy Common Uncommon Rare Never
Mechanical ventilation - invasive Common Uncommon Rare Never
Ultrasound Common Uncommon Rare Never
Flexible sigmoidoscopy Common Uncommon Rare Never
Treadmill exercise testing Common Uncommon Rare Never
Elective cardioversion Common Uncommon Rare Never


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Adrian Stevens.
Copyright © 2008 EFIM. All rights reserved.
Revised: 03/29/08